BMJ Open Quality最新文献

{"title":"Reducing unnecessary bed days to optimise flow and improve demand-capacity mismatch: learning from a system-wide patient flow collaborative.","authors":"Kenneth Jun Logrono, Mohamed Salem Khalil, Mohammed Abuqamar, Elizabeth Tamara Biong, Luay Alsmadi, Juliet Jalmasco, Pradeep Radhakrishnan, Khadija Al-Shukaili, Belal Salem Mufadi Zubi, Esmat Swallmeh, Emad Mraweh Mohammed Mustafa, Muna Al-Maslamani","doi":"10.1136/bmjoq-2025-003682","DOIUrl":"10.1136/bmjoq-2025-003682","url":null,"abstract":"<p><strong>Background: </strong>Discharge delays and unnecessary bed days (UBDs) are known to cause increasing Emergency Department (ED) boarding and account for over 20% of inappropriate hospital bed use. The aim of this project is to reduce the number of UBDs by 25% (from 1500 days to 1100 days) and increase bed availability at 7 a.m. by 15% (from 0 to 1-2 beds) for medical inpatient beds over a year.</p><p><strong>Methods: </strong>The implementation of change was facilitated by the Institute for Healthcare Improvement (IHI) Model for Improvement, with iterative testing through PDSA cycles. Quality improvement (QI) tools such as fishbone diagram, Pareto chart, and high-level flow diagrams were used to understand system drivers of delay and prioritise change ideas. Shewhart charts were used to distinguish between common-cause and special-cause variations.</p><p><strong>Results: </strong>The reasons for UBD and flow failures were classified as lack of capability, lack of capacity, lack of payment, patient refusal, and delayed planning. Within a year of initiating the QI project, UBDs decreased by 68% (from 1522.7 to 493.4 days), increased the availability of staffed beds at 7 a.m. by 87% (from 1.5 to 2.8 beds) and reduced ED pending admissions by 23% (from 12.1 to 9.3 patients). These improvements temporarily coincided with the implementation of several change ideas-integrated early discharge planning, the use of a CPS tool, and early involvement of social workers.</p><p><strong>Conclusion: </strong>Several systems and throughput factors, in addition to staff capacity, may contribute to increasing the availability of hospital beds and reducing UBDs. QI methods and tools can rapidly uncover, test, and implement opportunities for improving patient flow from ED to inpatient units.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 2","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13311690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148326744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimising ICU supply chains: Evidence-based strategies for efficiency, resilience and patient safety-a structured narrative review.","authors":"Noor Hasmee, Hema Joshi, Mamita Gurung, Bhupendra Singh, Saman Naseema","doi":"10.1136/bmjoq-2025-003422","DOIUrl":"10.1136/bmjoq-2025-003422","url":null,"abstract":"<p><p>Inventory management in intensive care units (ICUs) plays a critical role in ensuring uninterrupted patient care, yet it remains an underprioritised component of healthcare operations. This narrative review explores current challenges and evidence-based strategies for optimising ICU supply chains. Issues such as unpredictable demand, manual stock tracking, procurement inefficiencies and limited staff training often contribute to stockouts, expired supplies and delayed interventions. The COVID-19 pandemic further exposed systemic vulnerabilities, emphasising the need for resilient, technology-driven supply systems. A comprehensive literature search (2004-2025) was conducted across PubMed, Scopus, Web of Science and Google Scholar using keywords related to ICU inventory, artificial intelligence (AI) forecasting, radio frequency identification (RFID), procurement and digital health logistics. Findings were synthesised into thematic categories addressing core problems and interventions. Key strategies include implementing automated tracking systems, adopting AI-driven demand forecasting, standardising procurement policies, training ICU staff in inventory best practices and establishing emergency buffer stock. Emerging technologies such as digital twins and blockchain are highlighted for their potential to enhance transparency, responsiveness and planning accuracy. Additionally, fostering multisourcing supplier partnerships and optimising ICU storage space can further enhance system agility and reduce waste. In conclusion, ICU supply chains must evolve from reactive, manual systems to proactive, data-driven frameworks. Hospitals should invest in digital infrastructure, staff training and ethical procurement models to build resilient, cost-effective and patient-centred supply chains.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 2","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13295943/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148306856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality education initiative to reduce pressure ulcers in high-risk-admitted patients in low-resource settings.","authors":"Almas Fasih Khattak, Sulaiman Hussain, Bashir Ahmad, Madiha Khattak, Wagma Viqar Afridi, Barkatullah Khan","doi":"10.1136/bmjoq-2025-003722","DOIUrl":"10.1136/bmjoq-2025-003722","url":null,"abstract":"<p><strong>Background: </strong>Pressure injuries, although preventable, are a persistent challenge for admitted patients in hospitals globally, especially in low-resource settings. High-risk patients include the elderly, the immobile and those with terminal illness. A hospital-wide quality education initiative was launched at a tertiary care hospital after an increasing trend of pressure injuries was seen among inpatients across different units. This initiative aimed to assess the effectiveness of a simple, easy-to-use Turning Clock Tool to reduce the occurrence, severity and undesired outcomes of pressure injuries.</p><p><strong>Methods: </strong>The quality education initiative was implemented over 6 months in three stages: the preintervention stage from 1 November 2023 to 31 January 2024, the implementation and training stage during February 2024, and a postintervention stage from 1 March 2024 to 31 May 2024. All inpatients admitted for at least 24 hours were included in the study. Nurses and caregivers were trained on the use of the tool to reposition patients every 2 hours. The incidence of pressure injuries, location, staging and the duration of hospital stay were compared before and after the implementation of the tool.</p><p><strong>Results: </strong>There was a 77.36% reduction in the incidence of pressure injuries from 53 to 12 cases. All stage-3 pressure injuries were eliminated while a significant decrease in stage-4 pressure injuries was seen. The gluteal and sacral regions were the most affected parts of the body. Patients with advanced age were the most affected. Average length of stay dropped from 11 days to 5 days.</p><p><strong>Conclusion: </strong>The Turning Clock Tool evaluated effectiveness, feasibility and contextual significance for preventing pressure injuries in low-resource hospital settings. Its use not only decreased the incidence and severity of pressure injuries but also reduced the average length of hospital stays. The Turning Clock Tool can be used as a simple yet cost-effective model to prevent pressure injuries in similar resource-constrained settings globally.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 2","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13295971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148306880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimising the prostate cancer diagnostic pathway in a tertiary hospital in Karachi: a two-cycle quality improvement project.","authors":"Sohaima Samad, Hamna Samad","doi":"10.1136/bmjoq-2025-003899","DOIUrl":"10.1136/bmjoq-2025-003899","url":null,"abstract":"<p><p>Delays in the prostate cancer diagnostic pathway can prolong patient anxiety and delay treatment planning, particularly in high-volume resource-constrained settings. At Lifeline Hospital, Karachi, a care centre receiving approximately 60-70 suspected prostate cancer referrals per month, a baseline audit of the urology pathway (Cycle 1, November-December 2024) identified delays. Median referral-to-clinic, clinic-to-biopsy and biopsy-to-multidisciplinary team (MDT) intervals were 25.3, 28.0 and 18.3 days, respectively, and only 47% of patients completed diagnosis and treatment planning within the project's primary 8-week benchmark from referral. This benchmark was informed by internationally recognised standards, including National Institute for Health and Care Excellence NG12 referral criteria and the National Health Service England Faster Diagnosis Standard and adapted to reflect local service constraints. This quality improvement project was registered locally as a service evaluation.Following multidisciplinary stakeholder engagement and process mapping, three pragmatic interventions were introduced in early January 2025: (1) an additional weekly one-stop urology clinic, (2) expanded local anaesthetic transperineal biopsy capacity and (3) administrative prioritisation of urgent referrals, imaging coordination and MDT preparation. A reaudit of consecutive patients in Cycle 2 (January-February 2025) evaluated pathway performance after implementation.Median clinic-to-biopsy time fell to 16.8 days (reduction 11.2 days; 40%), and biopsy-to-MDT time decreased to 7.6 days (reduction 10.7 days; >50%). Referral-to-clinic time improved modestly to 22.3 days. The proportion of patients completing diagnosis and treatment planning within 8 weeks increased from 47% to 58%.This two-cycle quality improvement project shows that low-cost operational interventions targeting clinic capacity, biopsy access and administrative coordination can improve timeliness in prostate cancer diagnosis and treatment planning in a tertiary hospital setting. Further gains are likely to require better prediagnostic imaging pathways, faster reporting and sustained postproject monitoring. These findings offer a practical framework for tertiary hospitals in Pakistan aiming to optimise cancer diagnostic pathways within existing resource constraints.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 2","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13289136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148300880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing surgical site infections in paediatric cardiac surgery in a resource-constrained setting: a quality improvement initiative.","authors":"Shazia Mohsin, Tahira Gill, Aman Ulah Ghotto, Akbar Mistry, Harrison Samuel, Waleed Shezad, Muhammad Zaid, Muhammad Tariq Jameel, Muneer Amanullah, Babar Hasan","doi":"10.1136/bmjoq-2025-004059","DOIUrl":"10.1136/bmjoq-2025-004059","url":null,"abstract":"<p><strong>Problem: </strong>A newly established congenital cardiac surgery programme in a low-resource setting identified a high early surgical site infection (SSI) rate of 23% during the first 3 months, reflecting variation associated with small case volumes and evolving systems.</p><p><strong>Background: </strong>Global paediatric cardiac SSI rates range from 0.25% to 6%, but can exceed 20% in low and middle-income countries due to workflow variability, resource constraints and patient-related risk factors. Most SSI prevention bundles originate from high-income settings and require contextual adaptation. Quality improvement (QI) methods can strengthen reliability when tailored to local systems.</p><p><strong>Methods: </strong>A learning health system approach was used, combining process mapping, root cause analysis, a key driver diagram and four sequential Plan Do Study Act cycles. Interventions targeted reliability across the perioperative pathway. The primary outcome was SSI rate per 100 surgeries. Process measures included training completion, preoperative risk screening, wound documentation and structured review of moderate and severe infections. Balancing measures included length of stay, mortality rate, case cancellation rate and readmissions. Interventions included strengthened sterilisation and risk screening practices, a nurse-led wound clinic with 30-day follow-up and training in aseptic technique and hand hygiene.</p><p><strong>Results: </strong>Among 500 surgeries, 31 SSIs occurred. SSI rates decreased from 12 to 6 per 100 surgeries and reached 2 per 100 surgeries, before increasing to 6 then 5 per 100 surgeries in later phases. Process reliability improved across all measures, while balancing measures remained stable. Following sustainability actions, environmental cleaning compliance improved from 20% to 85% and hand hygiene from 45% to 90%.</p><p><strong>Conclusion: </strong>QI interventions were associated with reduced SSI rates, although sustained benchmark performance was not achieved. Continued monitoring and behaviour-focused strategies will guide further improvement.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 2","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13289249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148275612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel approach to the codesign of a tailored intervention bundle: applying theory with pragmatism.","authors":"Surakshya Pokharel, Onyebuchi Omodon, Douglas Woodhouse, Leah Ferrie, Diane Duncan, Ashi Mehta, Anshula Ambasta","doi":"10.1136/bmjoq-2025-003861","DOIUrl":"10.1136/bmjoq-2025-003861","url":null,"abstract":"<p><strong>Background: </strong>Theory-based design of tailored intervention bundles to address low-value care is an evolving science. Codesign approaches are increasingly being used to engage end-users in implementation projects. This manuscript outlines a pragmatic, theory-informed approach to codesigning an intervention bundle with physicians to address laboratory test overuse in hospitals.</p><p><strong>Methods: </strong>We used a qualitative approach to collect data during virtual audit and group feedback sessions based on the Calgary Audit and Feedback Framework between January 2021 and June 2021 across four hospitals in Calgary, Canada. Sessions were audio-recorded and transcribed, and detailed field notes were taken. In introductory sessions, participants identified barriers, facilitators, and intervention ideas for laboratory test overuse in hospitals. In follow-up sessions, they contextualised ideas using a patient-journey map and prioritised them with a matrix. We used the Theoretical Domains Framework to analyse barriers and facilitators and applied behaviour change techniques (BCT) to map physician-generated interventions to theory-based implementation strategies.</p><p><strong>Results: </strong>We conducted twelve sessions with 83 physicians representing family medicine and internal medicine specialties. Our pragmatic codesign approach with physicians emphasised assessing clinical stability when considering ordering practices and generated intervention ideas focused on stable patients. Physician-generated intervention ideas were mapped to the BCT taxonomy to inform the development of a tailored behavioural change intervention bundle to reduce overutilisation of laboratory testing in hospitals, consisting of (1) policy changes, (2) order system modifications, (3) education, and (4) audit and feedback.</p><p><strong>Conclusions: </strong>Our approach allowed the recognition of context-specific barriers and facilitators, engaged end-users to codevelop intervention ideas that addressed the identified barriers, and led to the development of a tailored multicomponent intervention bundle. This approach emulated effective application of BCTs to systematically identified barriers and facilitators. Further research is required to adapt this approach to other contexts to determine generalisability and to evaluate the effectiveness of this intervention bundle.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 2","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13288691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148275562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing ADA 2026 diabetes technology recommendations: opportunities and challenges for quality improvement in real-world care.","authors":"Khashayar Saybani, Ishani Ajantha Attanayake Mukaweti Sahabandu Mudiyanselage, Ainan Arshad","doi":"10.1136/bmjoq-2025-004114","DOIUrl":"10.1136/bmjoq-2025-004114","url":null,"abstract":"","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 2","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13289114/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148263069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating a quality improvement learning collaborative: qualitative evaluation of Using Labs Wisely.","authors":"Andrea M Patey, Varunaavee Sivashanmugathas, Gillian Hurwitz, Adina Weinerman, Janet Simons, Wendy Levinson","doi":"10.1136/bmjoq-2025-003906","DOIUrl":"10.1136/bmjoq-2025-003906","url":null,"abstract":"<p><strong>Background: </strong>Overuse of low-value laboratory tests can harm patients, waste healthcare resources and contribute to environmental damage. To address this, Choosing Wisely Canada launched <i>Using Labs Wisely</i> (ULW), a national learning collaborative designed to reduce unnecessary testing through shared data, training and quality improvement initiatives. ULW brought together hospitals of all sizes to implement stewardship projects, foster collaboration and monitor progress through a centralised data repository. This study evaluated ULW to identify successes, challenges and opportunities for improvement.</p><p><strong>Methods: </strong>We conducted a qualitative study using a theory-informed interview guide based on the Theoretical Framework of Acceptability (TFA). Fifteen hospitals in the first ULW cohort were invited to participate. Interviews with clinicians and managers explored experiences with ULW, including what worked, what did not and recommendations for improvement. Transcripts were analysed inductively using thematic analysis, with themes reviewed collaboratively and mapped to TFA constructs.</p><p><strong>Results: </strong>Thirteen hospitals participated, reflecting strong interest in reducing low-value testing and valuing ULW's structured, collaborative approach. Participants highlighted the programme's national credibility, resources and peer learning opportunities which facilitated institutional buy-in and elevated the laboratory's role in quality improvement. While generally manageable, common challenges included difficulties with data extraction, lack of standardisation across systems and limited human resources, particularly during pandemic-related strain. Participants called for expanded quality improvement training, clinical outcome tracking and cross-site collaboration to address increasingly complex and costly tests.</p><p><strong>Conclusions: </strong>ULW successfully supported hospitals to reduce low-value laboratory testing through structured improvement, benchmarking and peer learning. Challenges remain, particularly around data and resources, but the evaluation highlights key enablers and lessons that can inform the programme's evolution and guide future collaboratives in other healthcare settings.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 2","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13289139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148263045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving point-of-care ultrasound documentation among emergency medicine residents: a mixed-method implementation research study.","authors":"Miriyala Gaayathri, S Manu Ayyan, N Sreekumaran Nair, Anas Mohammed Muthanikkatt, Prudhvi Charan Reddy Miriyala, Gloria Valiyaveettil Justin","doi":"10.1136/bmjoq-2025-004098","DOIUrl":"10.1136/bmjoq-2025-004098","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effectiveness of a theory-informed, iterative implementation strategy (IS) to improve point-of-care ultrasound (POCUS) documentation compliance among emergency medicine (EM) residents according to American College of Emergency Physicians (ACEP) guidelines in a high-volume emergency department (ED).</p><p><strong>Methods: </strong>We conducted a 19-month (December 2023-June 2025) mixed-methods implementation study at a tertiary academic ED in India. The Consolidated Framework for Implementation Research (CFIR) and Expert Recommendations for Implementing Change guided six iterative IS phases, including education, co-design, workflow optimisation and audit/feedback. Participants were EM residents. The primary outcome was the proportion of POCUS examinations achieving ≥80% compliance with ACEP documentation standards. Compliance trends were analysed across phases and summarised using proportions and medians with IQRs. Qualitative data from five focus group discussions were analysed using CFIR to identify barriers, facilitators and mechanisms of change. Quantitative and qualitative findings were integrated using a joint display.</p><p><strong>Results: </strong>We assessed 3074 POCUS examinations. The proportion of scans achieving ≥80% compliance increased from 0% at baseline to 35.1% postimplementation. Median compliance rose from 24% (IQR 17-34) to 69% (IQR 54-84). Compliance followed a nonlinear trajectory. Initial phases showed minimal gains (0%-8.7%) due to workflow barriers. A marked acceleration occurred during IS-5 (22.5%) following the introduction of a user-designed, single multimodal form and gamification. Qualitative analysis demonstrated a shift from initial resistance (CFIR: compatibility, complexity) to normalisation (implementation climate), although technical challenges with image archiving persisted.</p><p><strong>Discussion: </strong>User-centred co-design and peer engagement were key to the improvement, although persistent infrastructure challenges limited further gains and highlighted the need for informatics-enabled solutions. This study demonstrates that low-cost, context-sensitive strategies can enhance POCUS documentation effectively in high-volume, resource-constrained EDs.</p><p><strong>Conclusions: </strong>A multifaceted, iterative IS guided by theoretical frameworks significantly improved POCUS documentation compliance. User-centred design and participatory engagement were critical mechanisms for sustainable practice change in a resource-variable EM setting.</p><p><strong>Trial registration number: </strong>CTRI/2024/03/063671.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 2","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13264939/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148223131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceived eye care risk and safety issues identified by optometrists in Scotland: a focus group study.","authors":"Dorothy Armstrong, James Graham, Lesley Rousselet, Paul Bowie","doi":"10.1136/bmjoq-2026-004182","DOIUrl":"10.1136/bmjoq-2026-004182","url":null,"abstract":"<p><strong>Introduction: </strong>Evidence on the nature and scale of risk and safety concerns in optometry practice is very limited, especially compared with other primary care professions. In Scotland, many changes occurred in the profession during and because of the COVID-19 pandemic. The theme of risk and patient safety was, therefore, chosen as the priority focus for the 2022 mandatory national training programme, which optometrists providing General Ophthalmic Services in Scotland are required to undertake.</p><p><strong>Aim: </strong>To explore and identify perceived current and future safety risks and how these might be mitigated in relation to professional optometry practice in Scotland.</p><p><strong>Methods: </strong>Study participants were all registered General Optical Council members from nine of the 14 regional health boards in Scotland. Data were collected via three online focus groups over a 2-month period during 2021 with each comprising six to eight participants. Data were transcribed with permission and then subjected to a basic thematic analysis.</p><p><strong>Results: </strong>16 optometrists participated in the study. Six principal themes were generated from the data analysis: (1) current overview and context (eg, perceived increased risk); (2) competency risks (eg, skills and knowledge to manage disease); (3) conduct risks (eg, behaviours of practitioners); (4) contextual risks (eg, environmental issues); (5) future risks (eg, technology) and (6) risk mitigations (eg, education and training).</p><p><strong>Conclusions: </strong>Optometrists participating in this study expressed concerns that the level of perceived clinical risk in the Optometry profession is increasing, mainly related to technology, scope of practice, role development and changes in consumer demand. Multiple recommendations are made to minimise reported risks including education for new roles; increased focus on improving care quality; support to those involved in safety incidents and complaints; taking a systems approach to areas of high risk and sharing good practices.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"15 2","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13311151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148216164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}